Rationale regarding the use of BCMA-targeted CAR T-cell therapy in relapsed/refractory multiple myeloma.
Deepu Madduri, MD: The rationale for using CAR [chimeric antigen receptor] T-cell therapy with BCMA-targeting antibodies in relapsed/refractory multiple myeloma comes from the fact that we found that BCMA is solely expressed on malignant plasma cells. Therefore, we want to have an antigen that we can possibly use that only targets and kills the bad myeloma cells, rather than killing healthy human cells. That was one of the reasons why BCMA is being used as a target in CAR T-cell therapies. We also see BCMA-targeted agents being used in bispecific antibodies. They’re also being used in antibody-drug conjugates, with Blenrep [belantamab mafodotin] becoming the first commercially available BCMA-targeted agent.
When we decide whether a patient should be treated with CAR T-cell therapy versus a bispecific, we look at how the patient is doing. We need to make sure the patient is not rapidly progressing, because it does take 3 to 4 weeks, or sometimes 5 weeks, to manufacture the CAR T cells. We want to make sure we have a therapy that the patient can actually get on after apheresis.
We also want to make sure the patient doesn’t have a lot of comorbid conditions and has a good performance status, because CAR T-cell therapies do have some underlying toxicities, such as cytokine release syndrome and neurotoxicity. We want to make sure the patient is healthy enough to handle these toxicities.
If a patient is rapidly progressing, or they’re elderly, or they have too many comorbidities, we usually prefer off-the-shelf agents like bispecific antibodies or antibody-drug conjugates. But if a patient is young, more fit, doesn’t have rapidly progressing disease that we can’t control with bridging chemotherapy, then we usually prefer to treat with CAR T-cell therapy first.
Transcript edited for clarity.
Understanding Risks and Training Needs for Outpatient Bispecific Usage
December 5th 2023During a Targeted Oncology™ Case-Based Roundtable™ event, Robert Mancini, PharmD, BCOP, FHOPA, discussed the various approved bispecific T-cell engagers and gave guidance for healthcare professionals, patients, and caregivers related to adverse event management. This is the second of 2 articles based on this event.
Read More
FDA Clears IND for CT071 in RRMM and Primary Plasma Cell Leukemia
December 5th 2023CT071, a chimeric antigen receptor T-cell therapy candidate, had an investigational new drug application cleared by the FDA for patients with relapsed/refractory multiple myeloma and primary plasma cell leukemia.
Read More
Hashmi Reviews Teclistamab Data for a Patient With R/R Multiple Myeloma
November 30th 2023During a Targeted Oncology™ Clinical Case Forum event in partnership with the South Carolina Oncology Society, Hamza Hashmi, MD, discusses the significance of the MajesTEC-1 of the bispecific T-cell engager teclistamab for patients with relapsed/refractory multiple myeloma.
Read More
Talquetamab Shows High Response Rates in BCMA-Pretreated RRMM
November 29th 2023During a Targeted Oncology™ Case-Based Roundtable™ event, Jonathan L. Kaufman, MD, discussed results of the MonumenTAL-1 trial of talquetamab in patients with heavily pretreated relapsed/refractory multiple myeloma. This is the first of 2 articles based on this event.
Read More
Connecting Heart Disease and Hematologic Malignancies
November 28th 2023A real-world analysis found that patients with acute coronary syndrome who were also diagnosed with a hematologic malignancy had worse survival outcomes, and patients with multiple myeloma were overrepresented in the population.
Read More